Provider Demographics
NPI:1649702929
Name:RENFROE, TAMIKA L
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:L
Last Name:RENFROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1736
Mailing Address - Country:US
Mailing Address - Phone:314-339-5872
Mailing Address - Fax:314-552-7591
Practice Address - Street 1:3737 N KINGSHIGHWAY BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1736
Practice Address - Country:US
Practice Address - Phone:314-339-5872
Practice Address - Fax:314-552-7591
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide